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Latest Posts

Do Doctors Feel That They Need Permission To Share Ideas?

Let’s say you’re a doctor and you have an idea, opinion, or a new way of doing things.  What do you do with it?

It used to be that the only place we could share ideas was in a medical journal or from the podium of a national meeting.  Both require that your idea pass through someone’s filter.  As physicians we’ve been raised to seek approval before approaching the microphone.

This is unfortunate.  When I think about the doctors around me, I think about the remarkable mindshare that exists.  Each is unique in the way they think.  Each sees disease and the human condition differently.  But for many their brilliance and wisdom is stored away deep inside.  They are human silos of unique experience and perspective.  They are of a generation when someone else decided if their ideas were worthy of discussion.  They are of a generation when it was understood that few ideas are worthy of discussion.  They are the medical generation of information isolation.

I spoke with a couple of students recently about Read more »

*This blog post was originally published at 33 Charts*

Deep Thoughts: Wisdom From The ER

If you’re alleging assault, don’t get loud with the Officer there to take a report. Especially if you have Felony warrants.

*This blog post was originally published at GruntDoc*

Finding Meaning In Illness: Lemons And The Demand for Lemonade

Jessie GrumanLife gives you lemons and you make lemonade…your response to all those cancer diagnoses is so positive, such a contribution!” “Your work demonstrates that illness is a great teacher.” ”Your illness has been a blessing in disguise.”

Well-meaning, thoughtful people have said things like this to me since I started writing about the experience of being seriously ill and describing what I had to do to make my health care work for me.  I generally hear in such comments polite appreciation of my efforts, which is nice because I know that people often struggle to know just what to say when confronted by others’ hardships.

But beneath that appreciation I detect a common belief about the nature of suffering from illness in particular, that in its inaccuracy can inadvertently hurt sick people and those who love them.

The belief is that sickness ennobles us; that there is good to be found in the experience of illness; while diseases are bad, they teach life lessons that are good. Read more »

*This blog post was originally published at CFAH PPF Blog*

The Role Of Experience In Medicine And Science

Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.

When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.

We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all.

Experience is valuable in other ways. First, there’s the “been there, done that” phenomenon. Older doctors have seen more: they may recognize a diagnosis that less experienced doctors simply have never encountered. My dermatology professor in med school told us about a patient who had stumped him: she had an unusual dermatitis of her hands that was worst on her thumb and index finger. His father, also a doctor, asked her if she had geraniums at home. She did. She had been plucking off the dead leaves and was reacting to a chemical in the leaves. The older doctor had seen it before; his son hadn’t. Read more »

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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